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Baby deaths prompt reviews

Julia Medew

Deaths were 29 per cent more likely at Mildura Base Hospital and 25 per cent more likely at Frankston Hospital. Photo: Justin McManus

SOME of Victoria's biggest maternity units are retraining staff in resuscitation and foetal monitoring after a state government report revealed the hospitals where babies were most likely to die.

Based on hundreds of perinatal deaths between 2005 and 2009, the report concluded deaths were 57 per cent more likely to occur at Latrobe Regional Hospital, 42 per cent more likely at Dandenong Hospital and 37 per cent more likely at Ballarat Base Hospital when compared to the state average.

Deaths were also 29 per cent more likely at Mildura Base Hospital and 25 per cent more likely at Frankston Hospital. Dandenong and Frankston hospitals care for about 2200 and 2700 births each year respectively, making them two of the state's busiest maternity hospitals.

One of the authors of the report, Associate Professor Glyn Teale, an obstetrician, said the results were based on a statistical analysis of deaths after 32 weeks' gestation called the perinatal mortality ratio. This includes stillbirths and those that occur within 28 days of life and excludes terminations after 32 weeks, deaths due to congenital malformations and very premature babies. The ratio allows hospitals to compare their death rates for similar patients with a state average.

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Professor Teale, who chairs the Victorian Maternity Safety and Quality Committee, said this meant hospitals with consistently high results were identified as outliers who should investigate the factors contributing to deaths and address them where possible.

There could be many causes, he said, including problems with quality of care, such as failing to pick up on restricted growth in foetuses, as well as differences in the health of mothers who might be obese, have diabetes or smoke - all factors that contribute to stillbirth.

''It may not be the organisation's fault, but they might be able to try to manage whatever they identify,'' he said.

The report did not specify the state average for perinatal deaths. But the latest government data shows there were 719 in 2008, including 504 stillbirths and 215 within the first 28 days of life. This data does not include terminations and a hospital breakdown is not published.

About 72,000 babies are born in Victoria each year.

Professor Teale said small rural hospitals and those with very few deaths per year were also excluded from the analysis because they were statistically invalid. ''It's a
particularly safe indicator because it's pooled data from over five years, so you're not looking at one year's bad luck,'' he said. ''As a clinician, as an obstetrician, it's the most powerful indicator.''

A spokesman for Frankston Hospital, John Dukes, said he did not know the cause of the hospital's perinatal deaths, but said staff realised there were too many in 2008, so asked Professor Euan Wallace - another member of the committee - to review the hospital's maternity services.

He said the review recommended more frequent resuscitation training for all paediatric staff, more foetal surveillance training for midwifery and obstetric staff, and more auditing of care. All the recommendations were adopted, Mr Dukes said, and staff were hoping for better results in future. ''We recognised a problem, we got Euan Wallace in and we fixed it,'' he said.

The chief medical officer at Latrobe Regional Health, Dr Simon Fraser, said the reasons for deaths at the hospital were ''complex and varied'', but said they were being reviewed and were reducing over time.

''Where we feel there is suggestions for improvement, we take them on board,'' he said.

The executive director of medical services at Ballarat Base Hospital, Philip Reasbeck, did not comment on the causes of its high perinatal death rate, but said a review of obstetric services had been launched, which included an external audit by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists this month.

Among other things, he said the hospital was working on its communication between staff, its assessment of pregnant women by senior obstetricians and was buying new equipment for intensive electronic monitoring of foetuses during labour.

The director of nursing at Mildura Base Hospital, Simone Heald, said she could not comment on any specific factors behind the deaths at her hospital, but said staff sometimes struggled to get women with complicated pregnancies flown to tertiary hospitals for more specialist care because of a lack of transportation.